Display options
Cite
Dube SK, Rath GP, Bharti SJ, et al. Causes of tracheal re-intubation after craniotomy: A prospective study. Saudi J Anaesth. 2013;7(4):410-4doi: 10.4103/1658-354X.121056.
Dube, S. K., Rath, G. P., Bharti, S. J., Bindra, A., Vanamoorthy, P., Gupta, N., Mahajan, C., & Bithal, P. K. (2013). Causes of tracheal re-intubation after craniotomy: A prospective study. Saudi journal of anaesthesia, 7(4), 410-4. https://doi.org/10.4103/1658-354X.121056
Dube, Surya Kumar, et al. "Causes of tracheal re-intubation after craniotomy: A prospective study." Saudi journal of anaesthesia vol. 7,4 (2013): 410-4. doi: https://doi.org/10.4103/1658-354X.121056
Dube SK, Rath GP, Bharti SJ, Bindra A, Vanamoorthy P, Gupta N, Mahajan C, Bithal PK. Causes of tracheal re-intubation after craniotomy: A prospective study. Saudi J Anaesth. 2013 Oct;7(4):410-4. doi: 10.4103/1658-354X.121056. PMID: 24348292; PMCID: PMC3858691.
Copy Download .nbib Format: NLM
Share it on

Saudi J Anaesth. 2013 Oct;7(4):410-4. doi: 10.4103/1658-354X.121056.

Causes of tracheal re-intubation after craniotomy: A prospective study.

Saudi journal of anaesthesia

Surya Kumar Dube, Girija Prasad Rath, Sachidanand Jee Bharti, Ashish Bindra, Pooniah Vanamoorthy, Nidhi Gupta, Charu Mahajan, Parmod Kumar Bithal

Affiliations

  1. Department of Neuroanesthesiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

PMID: 24348292 PMCID: PMC3858691 DOI: 10.4103/1658-354X.121056

Abstract

BACKGROUND: Re-intubation of neurosurgical patients after a successful tracheal extubation in the operating room is not uncommon. However, no prospective study has ever addressed this concern. This study was aimed at analyzing various risk factors of re-intubation and its effect on patient outcome.

METHODS: Patients aged between 18-60 yrs and of ASA physical status I and II undergoing elective craniotomies over a period of two yrs were included. A standard anesthetic technique using propofol, fentanyl, rocuronium, and isoflurane/sevoflurane was followed, in all these patients. 'Re-intubation' was defined as the necessity of tracheal intubation within 72 hrs of a planned extubation. Data were collected and analyzed employing standard statistical methods.

RESULTS: One thousand eight hundred and fifty patients underwent elective craniotomy, of which 920 were included in this study. A total of 45 (4.9%) patients required re-intubation. Mean anesthesia duration and time of re-intubation were 6.3±1.8 and 24.6±21.9 hrs, respectively. The causes of re-intubation were neurological deterioration (55.6%), respiratory distress (22.2%), unmanageable respiratory secretion (13.3%), and seizures (8.9%). The most common post-operative radiological (CT scan) finding was residual tumor and edema (68.9%). Seventy-three percent of the re-intubated patients had satisfactory post-operative cough-reflex. The ICU and hospital stay, and Glasgow outcome scale at discharge were not significantly affected by different causes of re-intubation.

CONCLUSION: Neurological deterioration is the most common cause of re-intubation following elective craniotomies owing to residual tumor and surrounding edema. A satisfactory cough reflex may not prevent subsequent re-intubation in post-craniotomy patients.

Keywords: Craniotomy; extubation failure; outcome; post-operative; tracheal re-intubation

References

  1. J Clin Anesth. 2003 Dec;15(8):575-81 - PubMed
  2. Anaesth Intensive Care. 1997 Aug;25(4):365-8 - PubMed
  3. Intensive Care Med. 2004 Jul;30(7):1334-9 - PubMed
  4. Pulm Pharmacol. 1996 Oct-Dec;9(5-6):285-92 - PubMed
  5. Lancet. 1975 Mar 1;1(7905):480-4 - PubMed
  6. Am J Respir Crit Care Med. 2000 May;161(5):1530-6 - PubMed
  7. Chest. 2003 Apr;123(4):1214-21 - PubMed
  8. Crit Care Med. 2008 Nov;36(11):2986-92 - PubMed
  9. Indian J Crit Care Med. 2008 Jan;12(1):1-9 - PubMed
  10. Chest. 2003 Jul;124(1):262-8 - PubMed
  11. Chest. 2001 Oct;120(4):1061-3 - PubMed
  12. Chest. 2001 Oct;120(4):1262-70 - PubMed
  13. Respir Care. 2007 Dec;52(12):1710-7 - PubMed
  14. Chest. 2006 Jan;129(1 Suppl):33S-47S - PubMed
  15. Anaesth Intensive Care. 1987 May;15(2):168-74 - PubMed
  16. Crit Care Med. 1998 Jun;26(6):1049-53 - PubMed
  17. Anesth Analg. 1990 Dec;71(6):691-7 - PubMed
  18. Surg Neurol. 2009 Oct;72(4):369-75 - PubMed
  19. Chest. 1997 Jul;112(1):186-92 - PubMed
  20. Am J Respir Crit Care Med. 1998 Dec;158(6):1855-62 - PubMed
  21. J Neurosurg Anesthesiol. 2011 Jan;23(1):25-9 - PubMed
  22. J Neurosurg Anesthesiol. 1999 Oct;11(4):282-93 - PubMed
  23. Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):658-64 - PubMed
  24. Neurocrit Care. 2008;9(1):83-9 - PubMed

Publication Types